2 total
Application for catastrophic impairment benefits dismissed as impairments were caused by non-accident life stressors.
The applicant sought statutory accident benefits, claiming catastrophic impairment due to physical and psychological injuries from a 2015 motor vehicle accident.
The Tribunal found that the applicant failed to prove causation on a "but for" basis, noting that his psychological impairments were primarily caused by significant non-accident life stressors, including financial ruin and family breakdown.
The Tribunal also found the applicant did not meet the threshold for catastrophic impairment under Criterion 7 (Whole Person Impairment) or Criterion 8 (Mental and Behavioural Disorders).
Consequently, the claims for a neuro-psychological examination, attendant care benefits, and housekeeping and home maintenance benefits were dismissed.
Catastrophically impaired applicant awarded attendant care and non-earner benefits; insurer penalized for unreasonably withholding payments.
The applicant sustained a catastrophic traumatic brain injury in a motorcycle accident and applied for statutory accident benefits.
The respondent denied several benefits, arguing the applicant was excluded for driving without a valid motorcycle licence and that his impairments were due to pre-existing conditions.
The Tribunal found the applicant's G1 licence was valid for the purpose of the Schedule's exclusion clause.
The Tribunal awarded non-earner benefits, attendant care benefits of $6,000 per month, and rehabilitation support worker services, finding the applicant suffered a complete inability to carry on a normal life and required 24-7 supervision.
A claim for $401,215 in home modifications was dismissed as excessive.
The Tribunal also granted a special award under O. Reg. 664, finding the respondent unreasonably withheld benefits by relying on flawed medical reports and ignoring its own adjuster's recommendations.
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